Delayed migration of K-wire into popliteal fossa used for tension band wiring of patellar fracture

Breakage of K-wires and stainless steel wires which are used for fracture fixation is not uncommon, but migration is rare. We report a case of migration of broken K-wire used for patella tension band wiring to the popliteal fossa. The broken hardware was removed surgically. We would like to suggest that K-wire and wire fixation used for treatment of patellar fractures can migrate into the posterior compartment of the knee and cause clinical symptoms. Close clinical and radiological follow-up after internal fixation to identify the presence of hardware breakage or movement and removal of wires once fracture has united can avert such complications.     

Delayed migration of K-wire into popliteal fossa used for tension band wiring of patellar fracture

Breakage of K-wires and stainless steel wires which are used for fracture fixation is not uncommon,but migration is rare.We report a case of migration of broken K-wire used for patella tension band wir...     

The cannulated osteo-support rod,a new device for the minimally invasive reduction of fractures

We report a newly developed device for fracture reduction and the positioning of K-wires, especially the guide wires of cannulated screws. It is designed as a cannulated ball spike pusher whose tip and inlay consists of a K-wire fixed in the lumina of the device by a screw. Thus, in displaced fractures, the (guide) wire can be inserted into the bone from the point of reduction, simplifying the intra-operative technique especially in minimally invasive procedures. Additionally, severely displaced fracture fragments can be handled quite comfortably percutaneously by using this device with a "joy stick" technique. The first practical experience in cannulated screw and K-wire osteosyntheses using this device are reported here.     

Popliteal vein pseudoaneurysm: a case report

This is a case report of an athletic, middle-aged man with a remote history of penetrating right leg trauma who developed a pulmonary embolism, thrombosis of the popliteal vein, a mass in the popliteal fossa, and acute ischemia of the right lower leg. At operation a thrombosed pseudoaneurysm was found arising from a defect in the popliteal vein with extrinsic compression of the popliteal artery. The defect was patched with autogenous vein and the long-term result was excellent. Pseudoaneurysm of the popliteal vein is a previously unreported entity. Popliteal venous aneurysms usually begin with phlebitic or pulmonary thromboembolic manifestations and present a diagnostic challenge. Venous aneurysms in general are uncommon pathologic entities with a diverse etiology; the current etiologic concepts and classification are briefly discussed in the text. A new differential diagnosis for masses in the popliteal fossa is introduced by this report.     

Pseudo-rupture of Extensor Pollicis Longus following Kischner wire fixation of distal radius fractures

We report two cases of extensor pollicis longus tendon tethering following K-wire insertion to treat unstable distal radius fractures, an unusual complication. In both cases, extensor pollicis longus function returned with conservative management. The structures considered "at risk" during K-wire insertion are described, and the common complications are discussed. Operative approaches to minimise soft tissue damage during K-wire insertion are reviewed. This case report is the first to demonstrate the potential for ultrasound scanning to aid in the diagnosis of extensor pollicis longus tethering.     

Migration intrarachidienne d’une broche de Kirschner après une cure de pseudarthrose de la clavicule. Cas clinique et revue de la littérature

Kirschner wires (K-wires) are often used for osteosynthesis particularly in the upper limb. Postoperative K-wire migration through the tissues is a well-recognised and significant complication of surgery of the clavicle, the wire ending up in the lungs, the oesophagus, the aorta, or the subclavian artery. Localisation of a K-wire migration into the spinal cord is very rare. We report the case of a 34-year-old man with K-wire migration into the spinal cord through the intervertebral foramen of T2, two months after surgery for nonunion of a fracture of the lateral clavicle. Apart from acute respiratory failure related to a pneumothorax, the patient initially had no neurological deficit. It was decided to operate on him immediately. Two therapeutic options are possible: simple K-wire removal via a supraclavicular approach, or the same but with direct visual control in the spinal cord after laminectomy. A postoperative check with an MRI scan is desirable after two days. Even if mechanism of K-wire migration is not known, the means of prevention are, namely strict postoperative immobilization, K-wire removal as soon as bone healing is achieved, and bending the external tip of each implanted wire.     

Aneurysm of the small saphenous vein presenting as a popliteal mass: a case report.

This report describes an aneurysm in the superficial small saphenous vein in a 44-year-old woman who presented with a popliteal mass. A venous aneurysm in this area is rare but should be among the differential diagnoses for a popliteal mass for optimal treatment and outcome.     

Intraligamentous suture of a scapholunar ligament lesion in a 9-year-old child

Scapholunate dissociation is a well-known injury in adult patients. In pediatric patients, repair of this injury in the skeletally immature carpus has been previously reported. However, in none of these case studies is single ligamentous suture performed.We report a case of scapholunate dissociation in a 9-year-old boy after an initial Salter I injury of the distal radius. After 6 weeks of wrist immobilization, arthroscopy was performed due to persisting pain over the scapholunate gap, a positive Watson sign, and limited range of motion. This arthroscopy revealed intraligamentous rupture of the scapholunate ligament. Suture repair of the scapholunate ligament was performed. The suture was protected by a temporary K-wire arthrodesis for 8 weeks. One year after removal of the K-wire, the patient is completely free of symptoms and resumes all sport activities.     

Migration of intra-articular K-wire into the contralateral pelvis after surgery for developmental dysplasia of the hip: a case report

Transarticular fixation of femoral head into acetabulum with K-wire is a seldomly used surgical method in difficult cases of developmental dysplasia of the hip (DDH). This paper presents a child with intrapelvic transvesicular migration of a K-wire without any symptoms after treatment of DDH. Eight years old girl who had multiple surgeries 4 years ago due to bilateral DDH applied to the orthopedics clinic with limping. She had good range of motion of both hips. At the pelvis radiograph, there was an intrapelvic K-wire standing between two hemipelvises like a bridge. She did not have any enteral and urological symptoms after the previous operations. We planned to remove the K-wire in cooperation with the pediatric surgery department. On the cystoscopy, K-wire was seen passing through the urinary bladder. Wire was cut at the middle point and taken out of the body by laparotomy. The patient was discharged without any postoperative complications. K-wire retention in the body has high chance of migration. Early postoperative removal of the K-wire is necessary to prevent possible complications.     

Pigmented villonodular synovitis presenting as a baker cyst

Pigmented villonodular synovitis (PVNS), a rare hyperproliferation of the synovial lining, commonly mimics other conditions. As a result, the diagnosis may remain elusive, as the classic signs of tenderness and effusion are not specific. Occasionally, PVNS presents as a popliteal cyst, which may divert attention from intra-articular pathology. In this article, we describe a case of PVNS that presented with a popliteal cyst as the chief problem report. In other cases PVNS presented as a popliteal cyst, and evidence was reported of PVNS within the cyst stalk and presumable intra-articular involvement. Our case did not present this way. We recommend that the diagnosis of PVNS be considered in young adults who present with a popliteal cyst.     

Surgical Management of Septic Arthritis of the Knee With a Coexistent Popliteal Cyst

We report a case of knee pyarthrosis in a 54-year-old woman with rheumatoid arthritis and a popliteal cyst. The onset of infection coincided with a cortisone injection. Initial management consisted of arthroscopic irrigation and debridement (I&D) on 2 consecutive occasions without resolution of the infection. Only after open excision of the popliteal cyst in conjunction with I&D of the knee joint proper did the infection resolve. This is the first reported case of a patient requiring excision of a popliteal cyst to clear pyarthrosis of the knee after failure of arthroscopic I&D. Consideration should be given to open debridement or drainage of popliteal cysts in patients who present with septic arthritis in the presence of a popliteal cyst. A treatment algorithm for managing this clinical scenario is presented.     

Spontaneous popliteal artery dissection: a case report and review of the literature

Spontaneous arterial dissection of a peripheral artery involving an extremity is a rare event. We report a case of atraumatic, nonaneurysmal dissection of the popliteal artery that occurred in a 62-year-old man who was admitted with progressive right lower-extremity claudication. Preoperative arteriography was suggestive of arterial dissection, and surgical treatment was undertaken before irreversible ischemia developed. Intraoperatively, a dissection of the popliteal artery was observed, and the patient underwent femoral-popliteal bypass grafting with the ipsilateral, greater saphenous vein and the popliteal artery was ligated distal to the dissection. Spontaneous dissection limited to the popliteal artery has not previously been reported in the literature. Successful management depends on consideration of the diagnosis, particularly when other, more common diseases have been excluded.     

The treatment of an osteochondral shearing fracture-dislocation of the head of the proximal phalanx: a case report

We report the morphology and treatment of a proximal interphalangeal joint dislocation resulting in an injury to the articular surface of the proximal phalanx and avulsion of the radial collateral ligament from its proximal origin. A large osteochondral fragment was sheared from the radial articular surface of the proximal phalanx and remained displaced volarly after reduction of the joint. Plain radiographs and 2- and 3-dimensional computed tomography images were used to evaluate this unusual injury before surgery. Open reduction and internal fixation using a small K-wire and figure-of-eight wire technique restored the articular surface of the head of the proximal phalanx and gave a satisfactory functional result.     

Ruptured mycotic aneurysm of the popliteal artery. A case report and review of the literature

We report a case of a ruptured mycotic popliteal artery aneurysm as a consequence of septic embolization from infective endocarditis. The clinical presentation and radiological findings are presented. The popliteal, tibio-peroneal, and the antero-tibial arteries were reconstructed using an in situ bifurcated saphenous vein graft. Follow-up at 24 months disclosed a patent repair with normal ankle-brachial index.     

Aspergillus infection of total knee arthroplasty presenting as a popliteal cyst. Case report and review of the literature.

Fungal infections have only rarely been reported to occur in patients having undergone total knee arthroplasty. This case report documents the first known case of Aspergillus fumigatus as the offending organism. Its initial presentation as a popliteal cyst further reinforces the known association of popliteal cysts and intra-articular knee pathology.     

Dissecting a popliteal cyst after failed unicompartmental knee arthroplasty

This report documents the first case of a popliteal cyst in a knee with failed unicompartmental knee arthroplasty (UKA). The cyst was treated successfully with the creation of a small communication hole between the posteromedial compartment and the popliteal cyst under direct arthroscopic visualization. This was followed by the replacement of a worn polyethylene insert via a small arthrotomy. Three months later, the popliteal mass had disappeared. This case suggests that a dissecting popliteal cyst may occur after UKA as one of the signs of a malfunction. It also suggests that treatment should be directed toward the joint and not the cyst itself.     

Watch out for the K-wire: painful experiences in two cases.

According to reviews in the literature, only a few case reports have mentioned the unusual migration of K-wires during orthopaedic surgery since 1991. This report emphasises the potential migration of the K-wire during plastic surgery in order to avoid the possible catastrophic complications.     

A popliteal venous aneurysm with deep venous thrombosis in the contralateral calf: report of a case

Although a popliteal venous aneurysm is a rare entity, it is an important cause of pulmonary embolism (PE), which is occasionally life-threatening. We herein report a case of a popliteal venous aneurysm with deep venous thrombosis (DVT) in the contralateral calf. A 65-year-old male, who presented with sudden onset palpitation and dyspnea, was transferred to our hospital. Enhanced computed tomography revealed PE and a venous aneurysm of the left popliteal vein. The popliteal venous aneurysm was saccular and had an intramural thrombus. Furthermore, duplex scanning detected DVT in the contralateral calf. The patient underwent a tangential aneurysmectomy with lateral venorraphy. The surgery and postoperative course were uneventful. The PE and calf DVT disappeared with perioperative anticoagulant therapy. It is recommended that, in the treatment of popliteal venous aneurysms, special attention should be given to the condition of the venous vessels of the contralateral leg, because this can influence the therapeutic strategy.     

Popliteal artery agenesis: a new anatomic variant

Agenesis of the popliteal artery has not been described as a vascular anomaly in the lower extremity. This case report describes congenital absence of the popliteal artery discovered during operative exploration after a traumatic injury to the lower extremity. The preoperative arteriogram suggested acute occlusion of the popliteal artery. Intraoperative exploration and arteriography were consistent with agenesis of the popliteal arterial segment, and postmortem examination confirmed these arteriographic and intraoperative observations. Embryologically, failure of the middle portion of the sciatic artery to persist would account for this anomaly. A review of series reporting congenital anomalies of the lower extremity vasculature failed to discover previous mention of this particular abnormality. Agenesis of the popliteal artery should be included among those vascular anomalies that may affect management of lower extremity vascular disease.